Trends in Gestational Weight Gain in Ontario, Canada from 2012 to 2022: A Population-Based Descriptive Study

Gestational weight gain (GWG) is a modifiable determinant of maternal and child health. We described the trends in GWG in Ontario, Canada from 2012 to 2022.

We conducted a descriptive study using population-based data from BORN (Better Outcomes Registry & Network) Ontario on all hospital-based singleton births. We assessed GWG continuously and categorically per Institute of Medicine (IOM) recommendations (inadequate, adequate, and excessive). Temporal trends were visualized using annual means and proportions by fiscal year, stratified by maternal socioeconomic, medical, and fetal characteristics. We used generalized estimating equations to examine temporal trends, with sequential adjustment for socioeconomic, medical, and fetal factors.

Among 1 054 973 births, mean GWG declined from 14.26 kg in 2012 to 13.75 kg in 2018, then increased to 14.19 kg by 2021. Unadjusted GWG decreased by 0.081 kg per year (95% CI -0.085 to -0.076), but after adjustment for socioeconomic, medical, and fetal factors, no annual change was observed (β = 0.004 kg per year; 95% CI -0.000 to 0.008). Stratification by BMI revealed an inverse gradient: persons with underweight BMI gained the most weight (15.16-15.91 kg), while those with class III obesity demonstrated the least gain (8.34-10.83 kg). However, these GWG ranges still did not meet the current IOM recommendations, with excessive GWG increasing from 52.8% to 55.2%, while adequate and inadequate GWG decreased.

GWG and adherence to GWG guidelines changed minimally over the study period, with a slight increase observed in 2020-2022, coinciding with the COVID-19 pandemic. Despite BMI category-specific trends toward recommended targets, GWG ranges did not comply with IOM weight recommendations.